Notices and Announcments

Important Notice Regarding Billing for Point of Use Convenience Kits
On June 30, 2015, Blue Cross and Blue Shield of Texas (BCBSTX) notified you of reimbursement changes regarding billing for Point of Use Convenience Kits for services rendered to our members would be effective starting Oct. 1, 2015. This message is to inform you that the correct date of the change is Nov. 1, 2015. We apologize for any inconvenience.

BCBSTX periodically reviews claims submitted by providers to help ensure that benefits provided are for services that are included in our member’s benefit plan and meet BCBSTX’s guidelines.

Some providers are submitting claims for point of use convenience kits that are used in the administration of injectable medicines. These prepackaged kits contain not only the injectable medicine, but also non-drug components including, but not limited to, alcohol prep pads, cotton balls, band aids, disposable sterile medical gloves, povidone-iodine swabs, adhesive bandages and gauze.

Effective Nov.  1, 2015, reimbursement for these point of use convenience kits will be reduced and BCBSTX will reimburse for the drug only and not the point of service kit.   Non-drug components included in the kits are inclusive of the practice expense for the procedure performed for which no additional compensation is warranted.

Typically, the cost of convenience kits exceeds the cost of its components when purchased individually. Services should be provided in the most cost effective manner and in the least costly setting required for the appropriate treatment of the member.

ICD-10: Approaching the Finish Line
As mandated by the U.S. Department of Health and Human Services, all Health Insurance Portability and Accountability Act (HIPAA) covered entities must use ICD-10 codes on claims and other health care transactions as of the Oct. 1, 2015, compliance deadline. 

Claim Submission Reminders
ICD-10 codes must be used on all claims with dates of service on or after Oct. 1, 2015, and inpatient institutional claims with dates of discharge on or after Oct. 1, 2015. As of the Oct. 1, 2015, compliance deadline, claims without valid ICD-10 codes, as required, will not be accepted by BCBSTX. Use of other codes, such as Current Procedural Terminology (CPT^®), HCPCS and Revenue Codes will not be impacted by the transition to ICD-10.

Testing End Date: Aug. 14, 2015
We want to thank those providers who participated in our ICD-10 Testing Program. BCBSTX began conducting end-to-end testing of electronic claims submitted by selected providers in April 2015. Testing is scheduled to continue through Aug. 14, 2015.

Benefit Preauthorization Update
In addition to claims, ICD-10 codes must also be used on other transactions, such as benefit preauthorization requests. BCBSTX will begin accepting ICD-10 codes as of Sept. 21, 2015, for benefit preauthorization requests for services that will be rendered on or after Oct. 1, 2015. Prior to submitting a benefit preauthorization request, we encourage you to check eligibility and benefits through your preferred online vendor portal.

For additional information, visit the Standards and Requirements/ICD-10 section of the BCBSTX provider website at bcbstx.com/provider. If you have ICD-10 questions, email us at icd@bcbstx.com, and we will be happy to assist. Or, contact your assigned Network Management Representative.

CPT copyright 2014 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

ClaimsXten^TM Adds Three New Outpatient Facility Rules, Effective Oct. 12, 2015
Beginning on or after Oct.12, 2015, BCBSTX will enhance the ClaimsXten code auditing tool by adding three new Outpatient Facility Rules into our claim processing system. The new facility rules will apply for any claims with dates of service on or after Oct.12, 2015. The new rules are summarized below:

Medically Unlikely Edits (MUE) Multiple Lines Facility Rule
This new facility rule identifies claim lines where the MUE has been exceeded for a Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) code, reported by the same provider, for the same member, on the same date of service.

An MUE is an edit that reviews claims for unit of service for a HCPCS or CPT code for services rendered by a single provider/supplier to a single beneficiary on the same date of service.

The ideal MUE is the maximum unit of service that would be reported for a HCPCS or CPT code on the vast majority of appropriately reported claims. The maximum allowed is the total number of times per date of service that a given procedure code may be appropriately submitted by the same provider.

Outpatient Code Editor (OCE) CMS CCI Bundling Rule
This new facility rule identifies claims containing code pairs found to be unbundled according to Centers for Medicare & Medicaid Services (CMS) Integrated Outpatient Code Editor (I/OCE). One of the functions of the I/OCE is to edit claims data to help identify inappropriate coding due to the following reasons: The procedure is a mutually exclusive procedure that is not allowed by the Correct Coding Initiative (CCI) and/or the procedure is a component of a comprehensive procedure that is not allowed by the CCI.

Unbundled Pairs Outpatient Rule
This new facility rule identifies the unbundling of multiple surgical codes when submitted on facility claims. This rule detects surgical code pairs that may be inappropriate for one of the following reasons: one code is a component of the other code, or these codes would not reasonably be performed together on the same date of service.

The ClaimsXten tool offers flexible, rules-based claims management with the capability of creating customized rules, as well as the ability to read historical claims data. ClaimsXten can automate claim review, code auditing and payment administration, which we believe results in improved performance of overall claims management.

To help determine how coding combinations on a particular claim may be evaluated during the claim adjudication process, you may continue to utilize Clear Claim Connection^TM (C3). C3 is a free, online reference tool that mirrors the logic behind BCBSTX’s code-auditing software. Refer to our website at bcbstx.com/provider for additional information on gaining access to C3.

For details regarding ClaimsXten, refer to the Education and Reference/ Provider Tools/Clear Claim Connection page on our provider website.  Information also may be published in upcoming issues of the Blue Review.

ClaimsXten and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc., an independent third party vendor that is solely responsible for it products and services.

CPT copyright 2014 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

Quick Guide to Member ID Cards Now Available
The BCBSTX Quick Guide to Blue Cross and Blue Shield Member Identification (ID) Cards* is now available on our provider website. The new guide will offer an overview of Blue Cross and Blue Shield ID cards, including what the symbols mean and how to use the information on printed on the ID card.

Always ask to see the current member identification cards at each visit along with a picture ID to help you identify the member’s product, network and health plan contact information. This interactive document allows you to easily navigate to specific topics of interest. The guide is available in the Claims and Eligibility/Eligibility and Benefits section of the BCBSTX provider website.

*Member ID cards are for identification purposes only and do not guarantee eligibility or payment of your claim. Always verify eligibility and benefits electronically through your Web vendor of choice. Checking eligibility and/or benefit information is not a guarantee of payment. Please note that the fact that a guideline is available for any given treatment, or that a service has been preauthorized, is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the back of the member’s ID card.

Help Your Patients Keep Their Health on Track with Our Healthy Family App
Healthy Family is an app that tells users, like your patients, which preventive services are recommended for them and their family. The app lets them know about important wellness screenings and immunizations, so they can take charge of their health and have informed conversations with you, their doctor.

With the BCBSTX Healthy Family app, your patients can:

• Get recommendations for them and their family based on age and gender
• Store past test information
• Set reminders for upcoming tests and add notes
• Available in English and Spanish

To get the Healthy Family app, text* FAMILY to 33633 or download it on the App Store or Google Play.

*Message and data rates may apply. (Terms and conditions and privacy policy.)

Online Resources Available for Claim Status
As a reminder, claim status is no longer available through the BCBSTX Interactive Voice Response (IVR) phone system. This change became effective July 13, 2015.

While our Customer Advocates remain available to discuss claim adjustments and other inquiries, BCBSTX supports electronic options as the most convenient, efficient and secure choice for requesting claim status information.

When conducting online transactions, you will need to use an electronic vendor portal. Some electronic vendors, such as Availity™ offer online tools for enhanced claim status, payment and remittance information. Following are two online tools available to registered Availity users:

• Claim Research Tool offers enhanced, real-time claim status functionality to help you manage and resolve your BCBSTX claims. This online tool allows you to search for claims by Member ID, group number or Document Control Number (DCN). You can customize your search to view claims according to status (paid, pended or denied) or by a particular date range and obtain detailed line item information (amount paid, ineligible reason code and description for each service line). It also enables you to check the status of multiple claims in one view.

• Remittance Viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by BCBSTX in the 835 Electronic Remittance Advice (ERA).

For more information on these and other electronic options available to BCBSTX independently contracted providers, visit the Education and Reference Center/Provider Tools page on the BCBSTX provider website.

For answers to frequently asked questions (FAQs) concerning the above-referenced change, refer to the IVR Claim Status Change FAQs in the Claims and Eligibility/Claims Status section of the website. A Claims Caller Guide also is available to assist you with navigating menu options on the IVR system.

If you would like to schedule a training webinar to learn more about online resources for claim status and other requests, email our Provider Education Consultants at pecs@bcbstx.com.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.